Setting the record straight
Untrue statements based on ignorance and fear run the very real risk of stigmatizing mental illness and treatment.
Given recent events, I find myself compelled to respond to the unfounded concerns about psychiatric medications voiced by the new person who has been put in charge at HHS. As a practicing doctor, trained and boarded in both Psychiatry and Family Medicine, as a trained public health services researcher, and as the Co-Chair of the Workgroup for Measurement-Based Care at the American Psychiatric Association, I feel the need to make some statements of truth.
The truth is that SSRI and SNRI medications are remarkably safe and non-addictive. And they’re far safer than untreated anxiety or depression. In my experience treating thousands of patients, and well described in the literature, there are occasionally people who have difficulty discontinuing them. This is rare, and absolutely incomparable to someone struggling to overcome opioid addiction. To equate the two is fear mongering, wreaks of anecdote and bias, and is an insult to all those who have struggled themselves, or lost a loved one to opioids.
It’s also true that these medications are tools. Like any tools, when used appropriately, they can be powerful and helpful. But there’s no tool that’s right for every situation. Not all cases of depression or anxiety are alike, and not everyone who struggles with those conditions is responsive to the biological effects of these meds. That helps to explain why not everyone benefits from taking them. I've also seen many people have remarkable turnarounds and improvements with the assistance of these treatments. For many, SSRIs and SNRIs play an essential role in their recovery. It's still not easy to predict who will benefit from what treatments, but we're getting better. And to continue on that path we need more unbiased science and discovery, not less.
The truth is that psychological trauma, interpersonal dynamics, and the environment at large play an influential role in anxiety and depressive disorders, just as they do with many other illnesses. There are no medications that can fix broken relationships, loneliness, or adverse experiences. It is also true that these meds are, at times, inappropriately sought after, and even over-prescribed, as a stand-alone approach to these social and environmental challenges. Many patients don't get an evaluation measuring and cataloging severity, and receive these medications for milder symptoms, when they may not be necessary. When we consistently measure and track a person's suffering, function, and symptom burden, we are often as likely to recommend against starting medication because we know it will be less effective when symptoms are milder. It's true that clinicians can and should do better about measuring and tracking symptoms, as well as educating patients on when medication is more or less likely to be helpful.
Finally, the truth is that when people in publicly visible roles make untrue statements based on ignorance and fear, those statements can spread like wildfire. And that runs the very real risk of setting back the important progress we’ve made as a society in destigmatizing mental illness and treatment.
We have to actively fight that spread with effective communication, science, data, reason, and decency. Please join me in a collective effort to share these truths by liking, commenting with your own insights, and sharing this with others. Ignorance breeds in fear and silence.